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{{Adrenal insufficiency}}
{{Secondary adrenal insufficiency}}
{{CMG}}
{{CMG}}{{AE}}{{ADS}}


==Overview==
==Overview==


There is no established system for the classification of [disease name].
Adrenal insufficiency is classified into 2 types based on the level of impairment, primary adrenal insufficiency and secondary adrenal insufficiency. Secondary adrenal insufficiency may be further classified based on the causes into three types, such as [[Hypopituitarism|hypopituitary]] causes, [[medication]] causes, and [[Genetics|genetic]] causes.  
 
OR
 
[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
 
OR
 
[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
[Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
 
OR
 
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
 
OR
 
If the staging system involves specific and characteristic findings and features:
According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
 
OR
 
The staging of [malignancy name] is based on the [staging system].
 
OR
 
There is no established system for the staging of [malignancy name].


==Classification==
==Classification==
Adrenal insufficiency is classified into 2 types based on the level of impairment.


*[Disease name] may be classified according to [classification method] into [number] subtypes/groups:
'''Primary adrenal insufficiency'''
**[group1]
* Primary adrenal insufficiency is due to impairment of the [[adrenal gland]], 80%  due to an [[autoimmune]] disease called [[Addison's disease]] or autoimmune adrenalitis. Also, the other cause includes [[autoimmune polyendocrine syndrome type 1]] and [[Autoimmune polyendocrine syndrome type 2|type 2]].
**[group2]
'''Secondary adrenal insufficiency'''
**[group3]
* Secondary adrenal insufficiency is caused by impairment of the [[pituitary gland]] or [[hypothalamus]]. The principal causes include [[pituitary adenoma]] (which can suppress production of [[adrenocorticotropic hormone]] ([[Adrenocorticotropic hormone|ACTH]]) and lead to [[Adrenal insufficiency|adrenal deficiency]] unless the endogenous hormones are replaced); and [[Sheehan's syndrome]], which is associated with impairment of only the [[pituitary gland]].
**[group4]
* Secondary adrenal insufficiency may be further classified based on the causes into three types:
OR
** [[Hypopituitarism|Hypopituitary]] causes
*[Disease name] may be classified into [large number > 6] subtypes based on:
** [[Medication]] induced
**[classification method 1]
** [[Genetics]]  
**[classification method 2]
**[classification method 3]
*[Disease name] may be classified into several subtypes based on:
**[classification method 1]
**[classification method 2]
**[classification method 3]
OR
*Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
OR
*If the staging system involves specific and characteristic findings and features:
*According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
OR
*The staging of [malignancy name] is based on the [staging system].
OR
*There is no established system for the staging of [malignancy name].
----
Three major types:
 
*Primary adrenal insufficiency
It is due to impairment of the adrenal glands. 80% are due to an autoimmune disease called Addison's disease or autoimmune adrenalitis. One subtype is called idiopathic, meaning of unknown cause. Other cases are due to congenital adrenal hyperplasia or an adenoma (tumor) of the adrenal gland.
 
*Secondary adrenal insufficiency
caused by impairment of the pituitary gland or hypothalamus.[2] Its principal causes include pituitary adenoma (which can suppress production of adrenocorticotropic hormone (ACTH) and lead to adrenal deficiency unless the endogenous hormones are replaced); and Sheehan's syndrome, which is associated with impairment of only the pituitary gland.
 
*Tertiary adrenal insufficiency
due to hypothalamic disease and a decrease in the release of corticotropin releasing hormone (CRH).[3] Causes can include brain tumors and sudden withdrawal from long-term exogenous steroid use (which is the most common cause).[4]


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{{familytree | | C01 | | | | | C02 | | | | | C03 |C01=•Addison's disease|C02= Hypopituitarism<br> •Tumors-Craniopharyngioma<br>  •Infections- Tuberculosis, Histoplasmosis <br>•Vitamin D deficiency|C03=Hypothalamic-Pituitary axis (HPA) suppression<br>  • Chronic High-dose steroids <br>• Abrupt withdrawal of Steroids <br> }}
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{{familytree |boxstyle=text-align: left | | C01 | | | | | | || | | | | C02|C01=•[[Addison's disease]]<br>•Autoimmune adrenalitis<br>•[[Autoimmune polyendocrine syndrome]] type 1 and type 2<br>•Idiopathic|C02= '''Hypopituitarism'''<br> •Tumors-[[Craniopharyngioma]]<br>  •[[Tuberculosis]]<ref name="pmid21509318">{{cite journal |vauthors=Al-Mamari A, Balkhair A, Gujjar A, Ben Abid F, Al-Farqani A, Al-Hamadani A, Jain R |title=A case of disseminated tuberculosis with adrenal insufficiency |journal=Sultan Qaboos Univ Med J |volume=9 |issue=3 |pages=324–7 |year=2009 |pmid=21509318 |pmc=3074785 |doi= |url=}}</ref><ref name="UpadhyaySudhindra2014">{{cite journal|last1=Upadhyay|first1=Jagriti|last2=Sudhindra|first2=Praveen|last3=Abraham|first3=George|last4=Trivedi|first4=Nitin|title=Tuberculosis of the Adrenal Gland: A Case Report and Review of the Literature of Infections of the Adrenal Gland|journal=International Journal of Endocrinology|volume=2014|year=2014|pages=1–7|issn=1687-8337|doi=10.1155/2014/876037}}</ref><br>  
  •[[Histoplasmosis]] <ref name="pmid23777028">{{cite journal| author=Bhansali A, Das S, Dutta P, Walia R, Nahar U, Singh SK et al.| title=Adrenal histoplasmosis: unusual presentations. | journal=J Assoc Physicians India | year= 2012 | volume= 60 | issue=  | pages= 54-8 | pmid=23777028 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23777028  }} </ref><br>•Pituitary infarction-[[Sheehan's syndrome]], pituitary apoplexy<br>•Removal of pituitary due to metastasis<br>•Lymphycytic hypophysitis<br>•Head trauma<br>•Intracranial artery aneurysms<br>'''Drugs'''<br>•Chronic high dose steroid<br>•Opiates- Codeine, Morphine<br>'''Genetic causes'''<br>•Isolated ACTH deficiency<br>•POMC deficiency<br>•Combined Pituitary Hormone Deficiency (CPHD)|}}
{{familytree/end}}
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Latest revision as of 17:02, 15 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]

Overview

Adrenal insufficiency is classified into 2 types based on the level of impairment, primary adrenal insufficiency and secondary adrenal insufficiency. Secondary adrenal insufficiency may be further classified based on the causes into three types, such as hypopituitary causes, medication causes, and genetic causes.

Classification

Adrenal insufficiency is classified into 2 types based on the level of impairment.

Primary adrenal insufficiency

Secondary adrenal insufficiency

 
 
 
 
 
 
 
 
Adrenal Insufficiency
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Primary adrenal insufficiency
 
 
 
 
 
 
 
 
 
 
 
Secondary adrenal insufficiency
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
•Addison's disease
•Autoimmune adrenalitis
•Autoimmune polyendocrine syndrome type 1 and type 2
•Idiopathic
 
 
 
 
 
 
 
 
 
 
Hypopituitarism
•Tumors-Craniopharyngioma
•Tuberculosis[1][2]
•Histoplasmosis [3]
•Pituitary infarction-Sheehan's syndrome, pituitary apoplexy
•Removal of pituitary due to metastasis
•Lymphycytic hypophysitis
•Head trauma
•Intracranial artery aneurysms
Drugs
•Chronic high dose steroid
•Opiates- Codeine, Morphine
Genetic causes
•Isolated ACTH deficiency
•POMC deficiency
•Combined Pituitary Hormone Deficiency (CPHD)

References

  1. ↑ Al-Mamari A, Balkhair A, Gujjar A, Ben Abid F, Al-Farqani A, Al-Hamadani A, Jain R (2009). "A case of disseminated tuberculosis with adrenal insufficiency". Sultan Qaboos Univ Med J. 9 (3): 324–7. PMC 3074785. PMID 21509318.
  2. ↑ Upadhyay, Jagriti; Sudhindra, Praveen; Abraham, George; Trivedi, Nitin (2014). "Tuberculosis of the Adrenal Gland: A Case Report and Review of the Literature of Infections of the Adrenal Gland". International Journal of Endocrinology. 2014: 1–7. doi:10.1155/2014/876037. ISSN 1687-8337.
  3. ↑ Bhansali A, Das S, Dutta P, Walia R, Nahar U, Singh SK; et al. (2012). "Adrenal histoplasmosis: unusual presentations". J Assoc Physicians India. 60: 54–8. PMID 23777028.

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